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| Comments on "Hsieh OpEd: Asking For Trouble in Health Care" |
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 | Tuesday, December 2, 2008 at 3:21:45 mst
Comment ID: #1
Name: Jim
E-mail: jwoodswce(at)aol.com
URL: http://jimwoods.thinkertothinker.com
Great op-ed.
One thing that I always wonder about universal health care, of course this is not the primary issue, what happens to access to abortion and emergency contraception when the government and possibly the religious right decides what is and is not paid for, and possibly what services can and can not be offered by a facility receiving federal funds?
It isn't like Obama will wave a magic wand, or executive order, and make the Hyde Amendment disappear.
Would Republicans jump on board the universal health care bandwagon in hopes of gaining financial leverage to end reproductive freedoms? Or just hijack it after the fact?
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| Tuesday, December 2, 2008 at 7:40:04 mst
Comment ID: #2
Name: Paul Hsieh
E-mail: paul(at)geekpress(dot)com
URL: http://www.geekpress.com
Jim: This is already an issue of partisan politics with respect to military health insurance (which is paid for by the federal government).
"Abortion Becomes Issue For Military"
http://www.military.com/NewsContent/0,13319,FL_abortion_081904,00.html
--- "One of President Clinton's first acts after taking office in 1993 was to lift a ban on abortions at U.S. military hospitals, giving servicewomen access to a procedure that had been available to civilians for 20 years. Two years later, the new Republican-controlled Congress reinstituted the ban..."
Currently, the military health plan only pays for abortions if the life of the mother is at risk. Abortions in the case of rape/incest are not covered financially.
Similarly, abortions for fetal deformities are not covered. Nor is abortion counseling:
http://tricare.mil/mybenefit/jsp/Medical/IsItCovered.do?kw=Abortion ...
Payments for abortion are also restricted for civilian employees of the federal government who are insured via the "Federal Employee Health Benefits Program".
Various interest groups may hope to change some of these rules under the new Obama Administration. But the bottom line is that abortion is already a political football for patients whose health insurance comes from the federal government (military personnel and federal employees), subject to the change of political parties' control over government. If any such insurance plans were extended to all of the American population, then we'd all be subject to these changes in political fortune.
And as you point out, the liberals who love the idea of "Medicare For All" may sing a different tune when Republicans some day regain control of Congress and the White House, and then use a "universal health care" system to impose their own views on the American population...
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| Tuesday, December 2, 2008 at 10:14:28 mst
Comment ID: #3
Name: Steve D'Ippolito
... just imagine if Hillary had succeeded with Hillarycare, with any payments outside the system becoming a felony! What then if the FedGov were forbidden from paying for abortions?
Would Hillarycare have banned charitable hospital work outside the system? If not that would have represented the only way of getting an abortion, if so, then the woman seeking an abortion would have been screwed (so to speak) a second time.
The Federal government providing health insurance is bad (though *possibly* justifiable in the case of its employees). In the current context, however, it seems that we should continue to forbid the FedGov to provide abortions as welfare, but insist that allow it for its own provided employee health insurance.
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In any case there is a larger point here: *Anything* the government pays for becomes a political football. Would (for example) prayer in public schools and teaching creationism be a *political* issue if the schools were not government funded? If they were not, then there would be Fundie schools churning out scientific illiterates to be sure, but they wouldn't be tax funded and my only recourse would be not to hire the ignoramuses (ignorami?) that come out.
(Instead for the moment the people who know what science is have the upper hand, thanks to the First Amendment, but the schools still churn out ignorami for different reasons.)
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| Tuesday, December 2, 2008 at 13:59:48 mst
Comment ID: #4
Name: Jonny Blaze
E-mail: j(at)blaze.com
Wrong wrong wrong. The financial crisis isn't caused by Community Reinvestment Acts. It's caused by the UNREGULATED credit default swaps. More regulation could have saved this.
On to health care, the reason for our current crisis is plain old GREED. Twenty years ago, various lobbying orgs like the AMA falsely predicted an oversupply of doctors, and thus helped pass laws to keep new medical schools from opening. Of course, they knew there would be no oversupply. The only thing that they care about is keeping the doctor supply low just so doctors can financially rape their patients.
So it was pure greed that deprives millions of Americans from fair-priced health-care. While there may be no 'right' to health-care, people have a right not to have lobbying groups compromise their health to make the rich even richer.
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| Tuesday, December 2, 2008 at 14:30:58 mst
Comment ID: #5
Name: Anonymous
I looked at the article "Moral Health Care vs. Universal Health Care" in TOS and its suggestions for moving towards a free market in medicine. One thing not mentioned there explicitly, though I think would agree with this, is that the government should not get into the business of recognizing who "doctors" are, and it should be free (not criminal) for anyone to practice medical activity with their patients consent. This opens up a the opportunity to provide lower cost health care, to those who can currently afford none at all.
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| Tuesday, December 2, 2008 at 14:52:51 mst
Comment ID: #6
Name: Tony Donadio
E-mail: tonydonadio(at)optonline.net
URL: http://www.repealthebailout.net
Jonny Blaze: I'll leave it to Paul to correct your misconceptions on health care, but you're completely wrong to suggest that the current financial crisis is the result of a lack of regulation. The financial market is one of the most regulated in the country. What's your argument that credit default swaps were to blame for the crisis? That's like blaming the insurance industry for earthquakes. Credit default swaps were just a symptom; it's the underlying investments that weren't sound. If they had been, then they wouldn't have gone bad and the problem wouldn't have happened in the first place.
And the entire market for those unsound investments was a creation of government. From the 1990s CRA enforcement that pressured banks into making sub-standard loans, to years worth of ridiculously low Fed rates, to GSE enabled bundling of mortgages that ballooned out of control unchecked, thanks to the implied promise of a government bailout on the "too big to fail" doctrine, it was government from start to finish that was primarily to blame for the crisis. Government regulation, and not a lack thereof, was what caused is crisis.
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| Tuesday, December 2, 2008 at 14:58:06 mst
Comment ID: #7
Name: RT
I just moved back to Canada with my (pregnant) wife and 2-year old in June, after 15 years outside the country. The healthcare situation is an abomination. Simply finding a doctor to take you as a new patient is a difficult chore often requiring many months waiting time. Since good doctors can't charge more (they just get the same government fee as everyone else), basically they fill up and stop taking new patients. So the only way to find a doctor is a) someone fresh out of medical school who is still building his patient list, or b) someone who for whatever reason doesn't have a full patient list -- with whatever that may imply.
We moved in mid-June, and the first appointment my wife could get with an obstetrician was mid-August. When some complications arose in July, repeated phone calls to this as-yet unseen obstetrician went unreturned. Finally in desperation we called our old obstetrician in the U.S. -- who answers his own cell phone and patiently spent 15 minutes discussing the possibilities and our options. Our only choice was to go to the emergency room to get checked out -- 8 hours later. Fortunately everything was fine in the end. It is amazing to me that in Ontario, it is illegal to pay for medical service. I have to wait in line for whatever level of care the government in its 'generosity' decides to give me. I can't just say: I'd like X, Y and Z tests and procedures, and I'm willing to pay for it. My doctor would go to jail if he agreed to that.
I feel sorry for the doctors, I feel like I am 'ripping them off' every time I go to them. I understand that they get $20 from the government for a regular visit. $20. The only way they can survive and pay their overhead is to rush people through as quickly as possible. In any other profession, if you want to get ahead, you constantly work to improve your performance so you can charge more for your services (or to get a raise, if you're an employee). For doctors here in Canada, since they just get a fixed fee per procedure no matter what, the only way they can make more money is via quantity -- rushing through more people faster. The good/conscientious doctors would never do that, so they get penalized, and perversely make less than the un-conscientious doctors.
At least right now I have the back-stop that if anything truly desperate occurs with my family's health, I can drive down to Buffalo for immediate and proper medical care -- which I will more than happily pay for. But if the U.S. goes down a similar route, we're all sunk.
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| Tuesday, December 2, 2008 at 15:02:12 mst
Comment ID: #8
Name: RT
Jonny, credit default swaps did not cause this crisis. A soviet-style central planning board manipulating interest rates (otherwise known as the Fed) to absurdly low levels of 1% in 2003, sparked the largest real-estate credit bubble in American history (real-estate credit grew approx 13%/year for many years). If we had gold, instead of fiat paper currency, and free-banking instead of highly-leveraged fractional-reserve banking encouraged by the Fed and FDIC, none of this would have happened.
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| Tuesday, December 2, 2008 at 15:10:46 mst
Comment ID: #9
Name: Kevin Clark
"If we had gold, instead of fiat paper currency, and free-banking instead of highly-leveraged fractional-reserve banking encouraged by the Fed and FDIC, none of this would have happened."
I'm in agreement with this but I have a question with regard to the fractional-reserve part. Is it fractional-reserve banking per se or just fractional-reserve banking in the context of legal tender laws and a central bank; ie of a socialized monetary system? I am thinking that fractional-reserve banking under laissez faire would be contractual.
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| Tuesday, December 2, 2008 at 15:16:27 mst
Comment ID: #10
Name: RT
I don't have a problem with fractional reserve banking under free banking, as long as it is fully disclosed. But the main point is that it would be minimal (maybe 1.5:1 or 2:1 at most) relative to the degree of leverage we have today (10:1 or more). The only way that the current degree of fractional reserve banking survives is due to the FDIC guaranteeing against bank runs, and the Fed acting as lender of last resort. Otherwise the discipline of free markets (the possibility of a bank run at any time) would force banks to pursue very conservative policies.
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| Tuesday, December 2, 2008 at 15:19:03 mst
Comment ID: #11
Name: Paul Hsieh
E-mail: paul(at)geekpress(dot)com
URL: http://www.geekpress.com
To: Anonymous
Yes, I agree that medical licensing should be eliminated. This is one of the points where I actually agree with "Johnny Blaze". I have another OpEd which is currently in the ARI pipeline in which I explicitly mention this point.
The ARI has also spoken out against government licensing of professionals (including licensing of physicians), and I agree with their position:
"End Government Licensing"
http://www.aynrand.org/site/News2?page=NewsArticle&id=15763& ...
I've also briefly discussed this issue on the FIRM blog at:
"The Dangers of Medical Licensing"
http://www.westandfirm.org/blog/2008/09/dangers-of-medical-licensing.html
Plus I've written in favor of allowing nurse practitioners and other non-physicians to provide health services at so-called "in store health clinice", in direct opposition to the monopolistic AMA (American Medical Association) stance on this issue:
"In-Store Health Clinics"
http://www.westandfirm.org/blog/2007/07/in-store-health-clinics.html
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| Tuesday, December 2, 2008 at 15:28:19 mst
Comment ID: #12
Name: Kevin Clark
RT,
Informative response. Thankyou.
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| Tuesday, December 2, 2008 at 22:45:52 mst
Comment ID: #13
Name: anon
Interesting, granted this is a single line from the Declaration of Independence--but after all, it is a document signed by all the Founders and gives a fairly good insight into their thinking: "We hold these truths to be self-evident... unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."
How can a citizen of this country be able to pursue their right to Life if they can't get adequate medical care?
The primary reason--and many physicians will tell you this--that health care in the US is failing is not because of over-regulation, but because of the stranglehold insurance companies have on the medical community. There is no 'competition' among the insurance companies, they set a rate and policies so that they can give the biggest dollar back to their shareholders, not their employees or the doctors providing the services. The supplier--vis a vis the doctor--is unable to play in a level playing field. Furthermore, premiums go to pay for the uninsured who are never refused service.
Why is it so difficult for libertarians to accept the premise that finding a way to pay for the uninsured will ultimately lower their health costs? Why is there an alarmist reaction when there's discussion of providing healthcare--real healthcare--for those who can't afford it? That it's a socialist agenda?
Why can't there be a hybrid approach?
OpEds like this are quite often light on facts. The author draws a loose allusion to the housing crisis and current economic debacle, pointing fingers at over-regulation and ignoring the fact that unregulated credit swaps are definitely to blame, at least partially.
Would anyone truly go to some person without a license to practice medicine? Would you really trust someone who wasn't board certified with your life?
Lastly, one of the big causes for the Great Depression was under-regulation and speculation. Up until the Great Depression, the country more or less operated under a stance of laissez-faire where there was NO middle-class and the vast majority of wealth was concentrated with a relative few.
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| Tuesday, December 2, 2008 at 23:16:19 mst
Comment ID: #14
Name: Kevin Clark
anon,
Your post is a laundry list of leftist fallacies about capitalism and its history. I don't have time to answer them but I would point your attention to the fact that the credit swaps allegation has already been dealt with in this thread. See the comments by RT and Tony Donadio.
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| Tuesday, December 2, 2008 at 23:31:04 mst
Comment ID: #15
Name: Paul Hsieh
E-mail: paul(at)geekpress(dot)com
URL: http://www.geekpress.com
To "anon": Many of the questions you've raised are covered in much greater detail in the earlier article written by Lin Zinser and myself, "Moral Health Care vs. 'Universal Health Care'", from the Winter 2007-2008 issue of The Objective Standard:
http://www.theobjectivestandard.com/issues/2007-winter/moral-vs-uni ...
I am no supporter of the current system of employer-based health insurance. And what you call the insurance "stranglehold" is a consequence of government policies begun in the 1940's which have distorted the market for decades. The current system is far from a free market, and the frustrations that many patients (and physicians) experience with the current system are all spillover effects of these initial government interventions in the free market.
Hence, to fix these problems, we need to correct the root causes and eliminate this government interference in the free market, not add to the problem with yet more regulations.
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| Wednesday, December 3, 2008 at 0:23:31 mst
Comment ID: #16
Name: madmax
"How can a citizen of this country be able to pursue their right to Life if they can't get adequate medical care?"
This is standard liberal fare, confusing human needs with human rights. Forcing one man to pay for the health care of another is to treat individuals as slaves who must live for the sake of others. And yet this type of Fabian slavery is passed of by welfare-statists as moral righteousness.
"Why can't there be a hybrid approach?"
There can be no mix between food and poison. As Ayn Rand said, only death wins. The same is true with capitalism and socialism (in this case Welfare-statism which is a temporarily watered down version). Controls lead to greater controls. This is exactly what we have been witnessing with the mortgage meltdown.
"Would anyone truly go to some person without a license to practice medicine? Would you really trust someone who wasn't board certified with your life?"
Licensing would be done by private organizations not by the government. And yes, privately licensed doctors would be trustworthy.
"Lastly, one of the big causes for the Great Depression was under-regulation and speculation."
Anti-capitalist rubbish. The cause of the Great Depression was regulation combined with the inflationary policies of the Federal Reserve whose sole purpose for existence is to finance the welfare-state. Though I am not a fan of Rothbard, his book on the Great Depression is must reading for anyone who wants to understand why it happened.
"Up until the Great Depression, the country more or less operated under a stance of laissez-faire where there was NO middle-class and the vast majority of wealth was concentrated with a relative few.'
Pre-1940's the country was economically freer but nowhere near laissez-fairre. As for the stuff about the non-existence of a middle-class, capitalism created the middle-class. Andrew Bernstein's "The Capitalist Manifesto" is a great book for discussing the history of capitalism.
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| Wednesday, December 3, 2008 at 21:48:25 mst
Comment ID: #17
Name: Anthony
"Is it fractional-reserve banking per se or just fractional-reserve banking in the context of legal tender laws and a central bank; ie of a socialized monetary system? I am thinking that fractional-reserve banking under laissez faire would be contractual."
If it's contractual, it's not really fractional-reserve banking. According to Wikipedia, "Fractional-reserve banking is the banking practice in which banks are required by governments to keep only a fraction of their deposits in reserve (as cash and other highly liquid assets) with the choice of lending out the remainder, while maintaining the simultaneous obligation to redeem all deposits immediately upon demand." I'd say, by definition, "fractional-reserve banking" includes two elements, the promise to redeem all deposits immediately upon demand, and the failure to keep all such deposits in reserve.
A bank could issue checking accounts without the promise to redeem all deposits immediately upon demand, but such checks wouldn't really be anything like checks as we know them - they'd be more like bonds or preferred stock certificates. There's nothing wrong with bonds or preferred stock certificates if you call them what they are. But issuing bonds or preferred stock certificates isn't what I'd call "fractional-reserve banking".
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